显微内窥镜椎间盘切除术的术中困难和并发症

目的 :对显微内窥镜椎间盘切除术 (microendoscopicdiscectomy ,MED)术中出现的困难和并发症进行分析 ,并探讨MED的技术特点。方法 :总结经MED治疗的 1 34例腰椎间盘突出症患者术中、术后及随访 2年以上的情况。结果 :术中出现的问题及术后并发症有 :(1 )定位错误 ;(2 )进入椎管困难 ;(3)止血困难 ;(4)损伤硬膜 ;(5)加重神经根炎症及水肿 ;(6)损伤椎间小关节 ;(7)髓核残留 ;(8)术后出血、粘连。 1 34例术后随访 2 4～ 42个月 ,症状改善率为 79 1 % ,病人满意率 93 2 %。 5例二次切开手术。结论 :MED技术优缺点兼有 ,术中出现的困难和并发症与器械因素和非器械因素有关。操作者对新技术的熟练掌握和不断改进器械性能可减少初期手术的困难和并发症

The difficulties and complications of microendoscopic discectomy(MED)

Objective:To study clinical difficulties and complications of microendoscopic discectomy(MED),and the technique features.Method:There was a clinical retrospective study about the surgical outcome of 134 patients operated with MED technique,according to the 50 scores grading system,they were follow up above 2 years.Result:The problems and the complications were:(1)The wrong level;(2)The difficulty of the entering into the spinal canal;(3)The difficulty of the controlling bleeding;(4)The injury of nerve root,or dural;(5)Postoperative edema and inflammation of nerve root;(6)Injury of the facet joint;(7)Incomplete removing the nuclear material;(8)Postoperative epidural bleeding,scar formation.After a follow up range from 24 to 42 months,the improving rate was 79.1%.The satisfied rate of patients was 93.2%.5 patients were surgically intervened second time for unaccepted reasons.Conclusion:MED has both outstanding and unsatisfactory features.The problems are including instrument and uninstrumented reasons.To prevent them and shorten the learning curve.Being familiar with the technique and improving the special instruments of MED are needed.